Local control and vertebral compression fractures following stereotactic body radiotherapy for spine metastases

Autor: H. Cem Onal, Berna Akkus Yildirim, Nese Torun, Erkan Topkan, Aylin Güneşli Yetişken, Ali Ayberk Besen, Yurday Ozdemir, Ozan Cem Guler
Rok vydání: 2019
Předmět:
0301 basic medicine
PSMA
prostate-specific membrane antigen
medicine.medical_specialty
lcsh:Diseases of the musculoskeletal system
Vertebral compression fracture
spMets
spine metastases
PET/CT
SUL
lean body mass SUV
medicine.medical_treatment
VCF
vertebral compression fractures
lcsh:RC254-282
SINS
spine instability neoplastic score
03 medical and health sciences
0302 clinical medicine
SBRT
stereotactic body radiotherapy
medicine
Bisphosphonate
SUV
standardized uptake values
Univariate analysis
PET-CT
SBRT
medicine.diagnostic_test
Spine metastases
business.industry
Incidence (epidemiology)
FFS
vertebral compression fracture-free survival
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
medicine.disease
030104 developmental biology
Oncology
Positron emission tomography
PERCIST
Positron Emission tomography Response Criteria in Solid Tumors
030220 oncology & carcinogenesis
Cohort
Radiology
lcsh:RC925-935
business
Progressive disease
Research Article
Zdroj: Journal of Bone Oncology
Journal of Bone Oncology, Vol 15, Iss, Pp-(2019)
ISSN: 2212-1374
DOI: 10.1016/j.jbo.2019.100218
Popis: Highlights • SBRT provides a satisfying local control rate of 88% in patients with spMets. • Post-SBRT vertebral compression rate of 4% corresponds to the current literature. • >6 months of bisphosphonates use is associated with lower fracture-free survival.
Purpose We aimed to retrospectively assess the incidence of vertebral compression fractures (VCF), examine clinicopathologic factors potentially associated with VCF, and evaluate treatment response in patients who received stereotactic body radiotherapy (SBRT) for spine metastases (spMets). Methods and Materials We identified 78 patients with 125 spMets at baseline and subsequent assessments. Patients received SBRT doses of 16 or 18 Gy. Patients with pre-existing VCF and co-existing local progression were excluded. Spine instability neoplastic score (SINS) was used for spMets categorization. Response to SBRT and VCF were assessed according to the Positron Emission tomography Response Criteria In Solid Tumors (PERCIST) and Genant scores, respectively. Kaplan–Meier analyses were used to assess local control of disease and vertebral compression fracture-free survival (FFS). Results We treated 103 cases with single spMets and 11 cases involving double spMets with SBRT. Progressive disease was reported in 3.2% and 8.2% of the cases in the first and last PET/CT reports, respectively. The distribution of treatment response in the remaining patients was: complete response in 30.6% of patients, partial response in 47.1% of patients, and stable disease in 22.3% of patients in the first PET/CT; complete response in 62.3% of patients, partial response in 16.7% of patients, and stable disease in 21% of patients at the last monitoring. Local failures were observed in 15 (12%) of cases. Median SINS was 5 (range: 1−13); majority of patients in our cohort (70.4%) were categorized as stable according to SINS, five (4%) patients had Grade 3 VCF at a median time of 16 months after SBRT (range: 2−22 months), and 60% of VCF occurred after an interval of at least 12 months after SBRT. No bisphosphonate usage was significantly associated with VCF (r = −0.204; p = 0.022). Median FFS was 21 months. Univariate analyses indicated that female gender (p 6 months of bisphosphonates use (p = 0.002), and the lowest vertebral body collapse score (p = 0.023) were associated with higher FFS. Female gender (p = 0.007), >6 months of bisphosphonates usage (p = 0.018), and the lowest vertebral body collapse score (p = 0.044) retained independent significance. Conclusions This study demonstrated that spine SBRT with doses of 16–18 Gy promises good local control of disease with acceptable VCF rates. Lowest vertebral body collapse score, female gender, and >6 months of bisphosphonate use were significantly associated with longer FFS.
Databáze: OpenAIRE
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